382: EHRLICHIOSIS-INDUCED MYOCARDITIS

Abstract

Introduction: Myocarditis caused by Ehrlichiosis is a rare manifestation. The following case emphasizes the significance of early detection and its treatment. Description: A previously healthy 77-year-old female presented with a two-day history of generalized weakness and altered mental status. On arrival, she had a fever of 101.5°F, a heart rate of 110 beats per minute, a respiratory rate of 26 breaths per minute, a blood pressure of 80/70 mmHg, and an oxygen saturation of 92% on low-flow nasal cannula oxygen therapy. She was disoriented without a focal neurologic deficit, and the remainder of the examination was unremarkable. Laboratory evaluation revealed leukocytosis at 22000 /mm3, thrombocytopenia at 34000 /mm3, troponins at 6300 ng/mL, creatinine of 3.0 mg/dL, and mild transaminitis. Her hepatitis panel, toxicology screen, urine, and blood cultures were negative. A lumbar puncture was not performed because of thrombocytopenia. Her pan-computed tomography (CT) scans were also unremarkable. Echocardiography revealed severe diffuse hypokinesia with a left ventricle ejection fraction of 20%. Cardiac catheterization was deferred due to renal dysfunction. Her empiric antibiotics regimen was de-escalated to doxycycline after peripheral smear, and a PCR test confirmed Ehrlichiosis. Her symptoms improved, and she was discharged to inpatient rehabilitation. An echocardiogram in 6 months showed an improved ejection fraction of 45%. Discussion: Ehrlichiosis usually manifests with symptoms of fever, myalgias, and malaise mimicking influenza-like illness. However, severe sequelae are more traditionally encountered at extreme ages. Myocarditis is a rare and fatal occurrence. The pathogenic mechanism driving cardiac involvement is still partially understood. It may cause cardiac damage or produce immunosuppression and inflammatory cell dysfunction, leading to nonspecific myocyte damage. We believe our patient had ehrlichiosis-related myocarditis, as evidenced by peripheral smear testing, profoundly raised cardiac enzymes, new-onset congestive heart failure, and recovery of cardiac function after treatment. In endemic locations, especially during the summer, it is prudent to keep suspicion of ehrlichiosis-associated myocarditis.